Features: A joined-up vision
The road to revalidation.
27 July 2009
The success of the revalidation pilots is dependent on the participation of doctors and a wide range of organisations involved.
To ensure that revalidation as a whole will be fit for purpose, pilots have been looking at other components, beyond the GMP framework, such as clinical governance requirements.
The School of Postgraduate Medical and Dental Education in Wales (Wales Deanery) and the GMC have been working together on one such project to assist healthcare organisations in identifying whether they have the processes in place to support and complement revalidation.
Wales GP and GMC Council member, Dr Malcolm Lewis, who chairs the GMC’s Continued Practice Board and sits on the UK Revalidation Programme Board, explains that the Wales Deanery and the GMC wanted to work with Local Health Boards in Wales to develop an assessment tool which would provide them with feedback on the readiness of their clinical governance and appraisal systems to support revalidation.
Supporting local systems
The project was also an opportunity to support Local Health Boards in Wales in preparing for the introduction of revalidation. Dr Lewis explains: ‘We focused on developing a methodology for evaluating appraisal, clinical governance and multi-source feedback systems operating in local healthcare organisations.
'At the outset, the project team reviewed existing organisational assessment methodologies to gain an overview of what worked well and would be most fit for purpose in this context. This approach was further explored through discussions with the Healthcare Inspectorate Wales, to enable analysis of its strengths and weaknesses in the context of this project.’
Explaining that a centralised system of appraisal is already available for all GPs in Wales, Dr Lewis went on to say that the results of the review in Wales were extremely encouraging and that Wales is pointing the way towards revalidation readiness.
Challenge for locums
Elsewhere, however, the pilots are indicating that there is still more to be done before revalidation can be launched and rolled out throughout the four countries of the UK. A team led by Dr Kwee Matheson for NHS Professionals working in partnership with NHS trusts, has been investigating what evidence locum doctors will be able to collect for revalidation.
The main challenge for the team has been getting locum doctors to get involved with the pilot. Dr Matheson says: ‘I think there’s a general lack of belief that revalidation is going to happen. If you’re just in a short-term post for one week or three weeks or even two months, it can be difficult to collect the information required to support an appraisal.’
She adds: ‘There’s still a lack of understanding of what revalidation involves and what sort of evidence locum doctors should be collecting. We get the sense that a lot of locums still believe it’s not going to happen or that they are going to be exempt. I think there is also the fear factor about appraisal and the consequences; they don’t know what appraisal is about; it’s all hearsay they get from their mates and so they don’t want to take part.’
However, Dr Kwee was keen to stress that the locum doctors who volunteered found their appraisals much less daunting than they had anticipated, and unexpectedly helpful and positive.
Private sector doctors
Doctors working primarily in the independent sector have also been raising questions about implementation. Director of Independent Healthcare Advisory Services and UKRPB member, Sally Taber, says: ‘The independent sector is really diverse and there are those doctors who work on their own or in very small environments without robust clinical governance support. So that’s one of the concerns.’
But, she says, work is being done to find a solution: ‘We’ve got a working group with the GMC consisting of the major independent sector providers; doctors from the cosmetic side; the Independent Doctors’ Forum; and the BMA.’
As a member of the UK Revalidation Programme Board, Sally will be reporting back on any concerns. ‘[The board] is a very dynamic working group at the moment, which is excellent. I just want to make sure that revalidation implementation does take on board the diversity of the independent sector and not just think of it as the NHS with a few independent hospitals. It’s really important that the non-managed environment is taken into consideration.’
Many of the pilots though are providing clear indicators that revalidation will be a useful tool both for aiding doctors’ professional development and for ensuring quality of healthcare.
In Buckinghamshire PCT, Associate GP Dean and Appraisal Lead, Marion Lynch, has found that a local project has led to ‘a real increased understanding of the range of evidence appraisees will need to collate.’ The Bucks team has created a checklist for doctors to use in practice, and as Marion explains: ‘The evidence collected, therefore, has been based on real-life scenarios.’
Roll-out
The current expectation is that local systems of appraisal and clinical governance could be ready to support revalidation in some areas or sectors by 2011. This would allow incremental roll out across the UK to commence thereafter. Vice-Chairman of the Academy of Medical Royal Colleges and UK Revalidation Board member, Dr Judith Hulf says: ‘I think we are at the stage now where the professional aspects of revalidation are certainly ready to be consulted on, and indeed trialled by professionals.
'That’s not to say that the whole process is ready to be rolled out but my position is that we can have in place the professional aspects of revalidation because in many ways it’s simply an extension of what doctors already do, with a few add-ons. But it’s a basis on which to build so that, when local processes and the Responsible Officers are in place, the professional aspects will be ready to be integrated with them and we can roll out.’